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SAN JOXQUIN COUNTY • , Page 1 <br /> ENVIRONMENTAL HEALTH DEPARTI .4T <br /> 1868 E HAZELTON AVENUE <br /> S TOCKTON, CA 95205 <br /> Phone: (209)468-3420 <br /> INVOICE Account ID AR0027281 <br /> Facility ID FA0015749 <br /> Date Printed 2/28/2014 <br /> ADAMS, DAVID RE : ADAMS AUTOMOTIVE <br /> ADAMS AUTOMOTIVE 1624 E ALPINE AVE <br /> 169 STOCKTON, CA 95205 <br /> OWNER : ADAMS, DAVID <br /> _—ProHealt_h _ _ __. _— ------__-- _ .-_ _ _._._. _._._._ _._----Anvount--t-- <br /> Data—_.- gram_ <br /> Description <br /> Invoice# IND249078---Date of Invoice: 113012014 I IIIIIII111111III IIIII IIIII IIIII IIIII IIIII IIIII IIIil lllll IIIII IN 1111111111111111111 <br /> 1/30/2014 1920 HMBP-Common Materials $ 100.00 <br /> 1/30/2014 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> 1/30/2014 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ - 35.00 <br /> Total forth--Inoc $ 348.00 <br /> SEGUNNUTNME Payment Due Date 31201 <br /> 4 <br /> TOTAL DUE this Billing Period $ 348.00 <br /> APRE QED <br /> R 0 g 2014 <br /> 5"L4 JOAQuIN <br /> EM4Rcku Cou" <br /> EALrH 0. <br /> ( i /C)c-kk--0- P&MS /Aol� e <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> For all SERVICE FEES <br /> Penalties will be added to all Permit Fees For HMBP Fees penalties will be added at the Rate of 10% <br /> at the Rate of 100°1 of the Base Fee Penalties will be added at tfte Rate of 10% 60 Da s after the Invoice Date and each 30 Days thereafter <br /> 30 Days after the Due Date 45 Days after the invoice Date Y <br />